Provider Demographics
NPI:1710186358
Name:NAGAMATSU, ERNEST T
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:T
Last Name:NAGAMATSU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 HILLHURST AVE
Mailing Address - Street 2:# 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027
Mailing Address - Country:US
Mailing Address - Phone:323-660-8088
Mailing Address - Fax:323-660-8083
Practice Address - Street 1:1655 HILLHURST AVE
Practice Address - Street 2:# 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-660-8088
Practice Address - Fax:323-660-8083
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice